Provider Demographics
NPI:1689124497
Name:WOODWARD HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:WOODWARD HEALTH SYSTEM LLC
Other - Org Name:ALLIANCEHEALTH WOODWARD CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:623 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-3126
Mailing Address - Country:US
Mailing Address - Phone:580-625-2273
Mailing Address - Fax:580-625-2274
Practice Address - Street 1:623 AVENUE C
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932-3126
Practice Address - Country:US
Practice Address - Phone:580-625-2273
Practice Address - Fax:580-625-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2252261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health